• In connection with my application for employment, I understand that a background report may be requested at will by (Client). The investigative consumer report will be requested from Rexus Corporation, a Consumer Reporting Agency. This investigative report may contain information as to my character, general reputation, personal characteristics or mode of living. This report may include such information as: education, verification of current and former employment, driving record, credit, bankruptcy proceedings, criminal records, etc., from federal, state, and other agencies which maintain such records.

    As set forth in the Fair Credit Reporting Act, I have the right to request from (Client), and the report provider, upon proper identification and written request, a copy of the consumer report as well as a written summary of my rights under the Fair Credit Reporting Act.

    The information requested will be used in compliance with the Fair Credit Reporting Act and/or any other applicable federal or state laws. I authorize any party, institution, school, employer or agency contacted by (Client). or its authorized representatives, to furnish the above-described information. I release from liability the agents, employers, and all other persons providing information. I hereby authorize procurement of the background report.

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  • Applicant: Please complete the following for proper identification purposes

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  • Last name used:Years name was used: 
  • Current AddressCityCountyState/ZipHow Long? 
  • For California, Minnesota or Oklahoma applicants only, if you would like to receive a copy of the consumer report, if one is obtained, please check this box:
  • For California applicants only, if public record information is obtained without using a consumer reporting agency, you will be supplied a copy of the public record information unless you check this box waiving your right to obtain a copy of the report: